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Trump’s Signed Order Works on a “Repeal and Replace” of the ACA; Price Comments on ACA Replacement Details

Posted on Friday, February 3, 2017 8:50 PM

As Congress works on a “repeal and replace” of the Affordable Care Act (ACA), the newly inaugurated President Donald Trump signed an executive order on January 20, “Minimizing The Economic Burden Of The Patient Protection And Affordable Care Act Pending Repeal.”

The order contains language directing heads of departments associated with ACA implementation and enforcement — presumably HHS, the Treasury Department and the Internal Revenue Service (IRS), among others — to “exercise all authority and discretion” to “waive, defer, grant exemptions from or delay the implementation of any provision or requirement of the act that would impose a fiscal burden on any state,” to “provide greater flexibility to states and cooperate with them in implementing health care programs.”

The wording is considered vague even by Republicans — Sen. Susan Collins, R-Maine, called it “confusing” — and experts say the fallout should be minimal. The “authority and discretion” clauses “suggest that no new power is given here,” says Daniel Skinner, assistant professor of health policy at Ohio University in Athens, Ohio. The order serves to “signal a new direction” to his cabinet; it “allows departments to prioritize or deprioritize in ways that facilitate weakening the law, sort of like Reagan did with theEPA [Environmental Protection Agency].”

Trump could potentially do damage to the ACA with executive orders. For example, “he can expand hardship exceptions for the individual mandate [and] grant Section 1332 innovation waivers that include things like work requirements, drop the appeal over cost-sharing subsidies, etc.,” says John F. Williams, former press secretary for the House Committee on Government Reform and Oversight and member of the Republican Senior Communications Staff Committee, now with law firm Hall, Render, Killian, Heath & Lyman in Washington, D.C.

On the other hand, “taking administrative steps to blow up the ACA while Congress is doing its thing would be very irresponsible, especially since Trump has promised a seamless transition,” Williams adds.

On January 23, Collins and Bill Cassidy, R-La., announced their intention to introduce in the Senate the Patient Freedom Act of 2017, which would meet Trump’s requirement to keep key ACA coverage requirements without requiring mandates.

Cassidy said that under the act, states could refuse any government plan or assistance, take the new plan or keep their ACA structure.

Collins said the ACA option, under which a state would keep all features of the status quo, makes their plan “unique” among proposed replacements to the ACA. She announced a “default” option that would have a “standard” plan with “a high deductible, basic pharmaceutical coverage [and] some preventive care such asfree childhood immunizations” that would be “financed by health savings accounts.”Cassidy also said the default plan would offer automatic enrollment, which he claimed would increase enrollment sufficiently to lower premiums by 20%, and suggested they would do away with high deductibles found in many ACA plans by “prefund[ing] a health savings account” with an “advanceable tax credit.” The plan also includes catastrophic coverage and pharmacy benefits and a “price transparency” feature for services.

After a January 18 hearing before a Senate committee, Tom Price, the nominee for HHS secretary, provided answers to specific questions asked by senators on the finance committee.

For example, when asked by Sen. Dean Heller, R-Nev., about what happens to Medicaid beneficiaries if the administration shifts to block grants, Price said they would “either retain that coverage or somehow have coverage through a different vehicle.”

Asked by Sen. Mark Warner, D-Va., whether he would use the recent executive order by President Trump to “cut back” ACA features, Price said “I don’t have all the answers,” but that “the people in the department have incredible expertise” and that he hoped his decision would be “informed” as secretary.

After intense questioning from Democrats on what they portrayed as Republican plans to repeal the ACA without a replacement or change Medicare to a premium-support program, Price was evasive, frequently saying these were matters of policy and he was “looking forward to working” with his interrogator to effect the relevant Congressional legislation as it emerged.

For the full article, please see the February 6, 2017 Home Health Line Edition.

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